For several years, pharmacists review cardiology ward prescriptions and communicate their IPs to cardiologists face-to-face or through our Prescription Management Software (PMS).

To highlight the main IPs realized by pharmacists in order to set up corrective actions with multidisciplinary brainstorming.

We analyzed oral and written IPs recorded on our PMS from April to December 2018 in the conventional cardiology hospitalization ward. Pharmacological IPs (P-IPs) were defined as intervention focused on medication: dose adaptation, drug-drug interaction, overuse/underuse, contraindication, non-compliance with guidelines, adverse effect, drug monitoring, inappropriate administration. Non-pharmacological IPs (NP-IPs) were defined as prescription issues impacting the medication circuit but not the patient therapeutical management.

On an 8-months period, 1628 patients have been hospitalized. Each prescription has been reviewed on average twice per patient during their hospitalization. About one fifth of patients have been concerned by IPs related to prescription review: 100 (32%) NP-IPs and 211 (68%) P-IPs presented in table 1. Prescribers accepted 81% of IPs. Among IPs concerning overdosage, dose adjustment was based on eGFR for 59%. The most involved medications were antigout agents (30%), antidiabetics (20%) and antibiotics (18%). Four out of 12 drug-drug interactions IPs concerned statins.

The high acceptance rate proves cardiologists’ confidence in pharmacists. NP-IPs represent 32%: in order to minimize it, a training is planned for new cardiology residents. A second analysis might show improvement. Most of P-IPs concern overdosage especially dose adjustment on renal function of non-cardiological drugs. A feedback is planned in order to raise cardiologists’ awareness of these issues. This shows one of pharmacists’roles in cardiology wards: optimizing patient care management in a multidisciplinary team.